Orbital Atherectomy as an Adjunct to Debulk Difficult Calcified Lesions Prior to Mesenteric Artery Stenting

Urgent endovascular maneuvers to rescue a failing transplant kidney with a T-stent approach - A case report

Renal artery thrombosis (RAT) is a major cause of renal transplant loss and, for this reason, should be treated promptly. We present a case of a 48-year-old man with external iliac thrombosis associated with thrombosis of a transplant renal artery that led to worsening of renal function. Multiple mechanisms have been identified in the literature as risk factors for RAT. In our patient, a combination of anastomotic stenosis, hypercoagulability, and diabetic nephropathy had resulted in RAT, and an unconventional endovascular revascularization technique with a T-stent approach was needed to guarantee patency of the treated vessels. No 30-day perioperative complications occurred, and the postoperative follow-up examination showed patency of the treated vessels; thus, transplant loss was avoided.

Successful Use of Adjunctive Orbital Atherectomy for Extensively Calcified Carotid Artery Lesions Using Flow Reversal Neuroprotection Technique

The use of transcarotid artery revascularization (TCAR) technique for carotid atherosclerotic disease has become increasingly popular as the endovascular alternative to traditional carotid endarterectomy. TCAR does offer a minimally invasive approach to carotid lesions, however, several technical and anatomic considerations, such as extensive calcification, limit its widespread applicability. Both orbital and rotational atherectomy are commonly used for extensively calcified lesions in the peripheral vasculature with satisfactory results for luminal gain. Herein, we describe the use of orbital atherectomy of a severely calcified ostial carotid lesion using reverse flow technique for neuroprotection during TCAR in a patient considered high risk for carotid endarterectomy.

Bifurcated Stent Technique: A Viable Option for Treatment of Patients With Unusual Anatomy Presenting With Combined Chronic Mesenteric Ischemia and Diffuse Ischemic Gastric Ulcers

Treatment of chronic mesenteric ischemia has evolved over the last two decades. Endovascular therapy is now the treatment of choice for patients with lesions amenable to such an approach. Open revascularization remains the standard of care but is frequently being reserved for lesions containing intraluminal thrombus or severe calcification. In most cases, celiac axis (CA) stenting is not needed since revascularization of the superior mesenteric artery (SMA) alone results in symptomatic resolution. This report describes a case of a patient with chronic mesenteric ischemia and diffuse gastric ulcers found to have a common origin of the SMA and CA that was treated endovascularly using a bifurcated stent technique.

Successful Use of Orbital Atherectomy as an Adjunct in Treating Extensively Calcified Mesenteric Artery Lesions

BACKGROUND

To describe the use of orbital technique of atherectomy as an adjunct to successful angioplasty and stent placement of the superior mesenteric artery (SMA).

CASE REPORT

The technique is demonstrated in a 68-year-old man with critical SMA stenosis. The SMA was cannulated with 0.014-in wire, but the lesion was highly stenotic and densely calcified and prevented the passage of even the smallest 1.5-mm balloon. Orbital atherectomy was thus performed with a 1.25-mm CSI crown. Balloon angioplasty was then possible with a 4 mm × 2 cm balloon followed by placement of a 7 mm × 22 mm balloon-mounted stent.

CONCLUSIONS

The use of atherectomy as an adjunct to angioplasty and stenting in extensive, calcified SMA lesions supports the value of this technique to avoid a much larger and morbid open procedure.